OBAMA: And then I will call Henry Waxman, and we'll just go back and forth.

BARRASSO: Thank you very much.

OBAMA: And because we are short on time, let's keep our remarks relatively brief.

BARRASSO: Thank you very much, Mr. President.

For people who don't know me, I practiced medicine in Casper, Wyoming for 25 years as an orthopedic surgeon, taking care of families in Wyoming. I've been chief of staff of the largest hospital in our state. My wife is a breast cancer survivor. Bobbi's been through three operations, a couple of bouts of chemotherapy. We've seen this from all the different sides of -- of care.

And this discussion needs to be about all Americans because everyone is affected, not just people that don't have insurance. And I've had dozens and dozens of visits to senior centers and town hall meetings and visited at -- at service clubs. And if you go to any community in America, and you ask the question, do you believe that this bill up here, that this bill will, if it becomes law -- do you believe you will pay more for your health care, you personally, every hand goes up.

And then you say, do you believe, if this bill becomes law, overall health care and the spending -- and spending in the country will go up, every hand goes up.

And then you ask the most personal question of all, do you believe, if this bill becomes law, the quality of your own personal care will get worse? Every hand goes up.

And most worried of all are the seniors, when you go to the senior centers, because they know there's going to be $500 billion taken away from those who depend upon Medicare for their health care. And it's not just Medicare Advantage. It's hospitals; it's the doctors; it's the nursing homes; it's home health, which is a lifeline for people that are home alone; hospice, for people in their final days of life.

That's all going to be cut. That's why the seniors are most concerned. And even the White House's own actuary says, if this goes into play, one in five hospitals, one in five nursing homes will be operating at a loss in 10 years. That's what we're looking at.

Now, for 25 years practicing medicine, I never asked anybody if they were a Republican or a Democratic or an independent and asked if they had insurance or not. I took care of everybody.

And many, many doctors -- and I know Dr. Coburn, Dr. Boustany -- do that. We take care of everyone, regardless of ability to pay. Doctors work long hours. Nurses work long hours.

And, Mr. President, when you say, with catastrophic plans, they don't go for care until later, I say sometimes the people with catastrophic plans are the people that are best consumers of health care, in using -- the way they use their health care dollars.

Because a lot of people come in and say, you know, my knee hurts; maybe I should get an MRI. They say -- and then they say, "Will my insurance cover it?" That's the first question.

And if I say yes, then they say, "OK, let's do it." If I say no, then they say, "Well, what is it going to cost?"

And "What's it cost?" ought to be the first question. And that's why, sometimes, people with catastrophic -- catastrophic health plans ask the best questions, shop around, are the best consumers of health care.

But to put 15 million more people on Medicaid, a program where many doctors in the country do not see them, as Grassley said -- you know, you say, how are going to help those folks?

And, Mr. President, you know, when I talk to doctors, I say, I have a way; put all the doctors who take care of Medicaid patients under the Federal Torts Claims Act. That will help them, because they're not getting paid enough to see the patients. But if their Medicare -- if they accept those patients and then their liability insurance is covered under the Federal Tort Claims Act, I think you have a lot more participation in that program.

I do believe we have the best health care system in the world. That's why the premier of one of the Canadian provinces came here just last week to have his heart operated on. He said it's my heart; it's my life; I want to go where it's the best, and he came to the United States.

It's where a member of parliament, a Canadian member of parliament with cancer came to the United States for their care. They all have coverage there, but they want is care. So coverage does not equal care.

What we heard from Senator Conrad is actually -- is also right. Half of all the money we spend in this country on health care is on just 5 percent of the people. Those are people, for the most part, that eat too much, exercise too little and smoke. And as a result, we need to focus on those people.

So the focus ought to be on the best possible care. People are happy with the quality of care they get and the availability, but they sure don't like the affordability because it's not affordable.

And, you know, Mr. President, the first week in medical school, we got our stethoscopes, and the professor of cardiology, who just died this past year -- he said this is to listen. This is to listen to your patients, listen to their heart, listen to their lungs. But it's a constant reminder to listen to them, listen to what they are telling you. And it means to listen to the other people in the room. If you're seeing a child, listen to what the mother is saying. If you're with an elderly person, listen to what their -- their adult child is saying. And it's a constant reminder to listen.

And I have great concerns that people around this table are not listening to the American people and are fearful of the consequences of this large bill, which is why only one in three people of American support what is being proposed here. And that's why so many people, Mr. President, are saying it's time to start over.

OBAMA: The -- I mean, let me just -- there's one thing I've got to -- there are a number of issues, as usually, that I've got significant difference with.

I just am curious. Would you be satisfied if every member of Congress just had catastrophic care? Do you think we'd be better health care purchasers?

I mean, do you think -- is that a change that we should make?

BARRASSO: Yes, I think -- I think, actually, we would. We'd really focus on it. You'd have more, as you'd say, skin in the game...

OBAMA: Because...

BARRASSO: ... and especially if they had a savings account...

(CROSSTALK)

BARRASSO: ... a health savings account. They could put their money into that and they'd be spending the money out of that.

OBAMA: Would you feel the same way if you were making $40,000 or you had -- that was your income?

Because that's the reality for a lot of folks. I mean, it is very important, when you say to listen, to listen to that farmer that Tom mentioned in Iowa, to listen to the folks that we get letters from.

Because the truth of the matter, John, is they're not premiers of any place. They're not sultans from wherever. They don't fly in to Mayo and suddenly, you know, decide they're going to spend a couple million on the absolute best health care. They're folks who are left out.

OBAMA: And this notion somehow that for them the system was working and that if they just ate a little better and were better health care consumers they could manage is just not the case.

The vast majority of these 27 million or 30 million people that we're talking about, they work, every day. Some of them work two jobs. But if they're working for a small business they can't get health care. If they are self-employed, they can't get health care.

And you know what? It is a scary proposition for them.

And so we can debate whether or not we can afford to help them, but we shouldn't pretend somehow that they don't need help. I get too many letters saying they need help.

And so I want to go to...

BARRASSO: Mr. President, having a high deductible plan and a health savings account is an option for members of Congress and federal employees...

OBAMA: That's right, because members of Congress get paid $176,000 a year.

(CROSSTALK)

BARRASSO: ... 16,000 -- 16,000 employees take advantage of that.

OBAMA: Because they -- because members of Congress...

(CROSSTALK)

BARRASSO: It's the same plan that the -- that the park rangers get...

OBAMA: John...

BARRASSO: ... in Yellowstone National Park.

OBAMA: John, members of Congress are in the top income brackets of the country, and health savings accounts I think can be a useful tool, but every study has shown that the people who use them are folks who've got a lot of disposable income. And the people that we're talking about don't.